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Flannery RB, Flannery GJ. Public Works Employees and Posttruamatic Stress Disorder: an At-Risk Population. Psychiatr Q 2023; 94:531-540. [PMID: 36808046 DOI: 10.1007/s11126-023-10014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
Although not widely known, public works employees in the United States were designated as emergency providers during critical incidents in 2003 and have provided these public works services, when activated. These public works employees may be either employees of a specific government entity or, more recently, privately contracted employees who provide similar services for a government entity. First responders working critical incidents are at risk for psychological trauma and posttraumatic stress disorder (PTSD). It is less clear, however, whether government/contracted public works employees working the same critical incidents are subject to the same risk of onset. This paper reviewed 24 empirical studies assessing this possible association from 1980 to 2020. These studies included 94,302 government/contracted employees. Psychological trauma/PTSD was reported in all 24 manuscripts assessing PTSD. Three of these studies additionally reporting serious somatic health problems. Public works employees are at risk for onset and this is a worldwide issue. Study findings and treatment implications are presented.
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Affiliation(s)
- Raymond B Flannery
- The University of Massachusetts Chan Medical School, Worcester, MA, USA.
- , Newton, MA, USA.
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Azofeifa A, Martin GR, Santiago-Colón A, Reissman DB, Howard J. World Trade Center Health Program - United States, 2012-2020. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2021; 70:1-21. [PMID: 34499632 PMCID: PMC8480994 DOI: 10.15585/mmwr.ss7004a1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PROBLEM/CONDITION After the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area). REPORTING PERIOD COVERED 2012-2020. DESCRIPTION OF SYSTEM The U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC's National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members' authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012-2020. RESULTS In 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44-57) in 2012 and 59 years (IQR: 52-66) in 2020. During 2012-2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458). INTERPRETATION Since 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions. PUBLIC HEALTH ACTION Analysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making.
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Abstract
OBJECTIVE To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer. METHOD We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service. RESULTS We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer. SIGNIFICANCE OF RESULTS This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.
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Daniels RD, Clouston SAP, Hall CB, Anderson KR, Bennett DA, Bromet EJ, Calvert GM, Carreón T, DeKosky ST, Diminich ED, Finch CE, Gandy S, Kreisl WC, Kritikos M, Kubale TL, Mielke MM, Peskind ER, Raskind MA, Richards M, Sano M, Santiago-Colón A, Sloan RP, Spiro A, Vasdev N, Luft BJ, Reissman DB. A Workshop on Cognitive Aging and Impairment in the 9/11-Exposed Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E681. [PMID: 33466931 PMCID: PMC7830144 DOI: 10.3390/ijerph18020681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Sean A. P. Clouston
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Charles B. Hall
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Kristi R. Anderson
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - David A. Bennett
- Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Evelyn J. Bromet
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Geoffrey M. Calvert
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Tania Carreón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Steven T. DeKosky
- McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA;
| | - Erica D. Diminich
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Caleb E. Finch
- USC Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA;
| | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - William C. Kreisl
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY 10032, USA;
| | - Minos Kritikos
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Travis L. Kubale
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Michelle M. Mielke
- Division of Epidemiology and Department of Neurology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA;
| | - Elaine R. Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Murray A. Raskind
- Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Marcus Richards
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK;
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Richard P. Sloan
- Division of Behavioral Medicine, Columbia University, New York, NY 10027, USA;
| | - Avron Spiro
- Boston University Schools of Public Health and Medicine and Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA;
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH) & Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
| | - Benjamin J. Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Dori B. Reissman
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
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Petereit-Haack G, Bolm-Audorff U, Romero Starke K, Seidler A. Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9369. [PMID: 33327657 PMCID: PMC7765156 DOI: 10.3390/ijerph17249369] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.
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Affiliation(s)
- Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Giessen, Justus-Liebig-University, 35392 Giessen, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
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World Trade Center Health Program: First Decade of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197290. [PMID: 33036199 PMCID: PMC7579473 DOI: 10.3390/ijerph17197290] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
The terrorist attacks on 11 September 2001 placed nearly a half million people at increased risk of adverse health. Health effects research began shortly after and continues today, now mostly as a coordinated effort under the federally mandated World Trade Center (WTC) Health Program (WTCHP). Established in 2011, the WTCHP provides medical monitoring and treatment of covered health conditions for responders and survivors and maintains a research program aimed to improve the care and well-being of the affected population. By 2020, funds in excess of USD 127 M had been awarded for health effects research. This review describes research findings and provides an overview of the WTCHP and its future directions. The literature was systematically searched for relevant articles published from 11 September 2001 through 30 June 2020. Synthesis was limited to broad categories of mental health, cancer, respiratory disease, vulnerable populations, and emerging conditions. In total, 944 WTC articles were published, including peer-reviewed articles funded by the WTCHP (n = 291) and other sources. Research has focused on characterizing the burden and etiology of WTC-related health conditions. As the program moves forward, translational research that directly enhances the care of individuals with chronic mental and physical health conditions is needed.
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Pasin L, Sella N, Correale C, Boscolo A, Mormando G, Zordan M, Landoni G, Navalesi P. Pandemic COVID-19: the residents' resilience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020120. [PMID: 33525201 PMCID: PMC7927552 DOI: 10.23750/abm.v91i4.10061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
Background and aim of the work: Healthcare workers are often exposed to secondary traumatic stress. The SARS-CoV-2 outbreak caused intense psychological pressure in various healthcare professionals, with increased risk of post-traumatic stress disorder. Objective of our study was to evaluate the incidence of post-traumatic stress disorder in italian residents in Intensive Care and Emergency Departments facing COVID-19 emergency. Methods: We developed a short, anonymous web-questionnaire to obtain data regarding sociodemographic, professional characteristics, history of psychological trauma, psychotherapy, use of psychiatric medications and the presence of symptoms of post-traumatic stress disorder. Primary outcome was the incidence of post-traumatic stress disorder. Secondary endpoint was to identify possible risk factors associated with the development of post-traumatic stress disorder. Post-traumatic stress disorder symptoms were assessed by the Impact of Event Scale-Revised. A cut-off of 33 identified a probable diagnosis of post-traumatic stress disorder while a cut-off of 22 identified subclinical post-traumatic stress disorder. Results: 503 residents completed the questionnaire. Among residents who were directly involved in the clinical assistance of COVID-19 patients, 34.3% presented a probable diagnosis of post-traumatic stress disorder, while 21.5% presented subclinical post-traumatic stress disorder. Female gender and history of psychological trauma were significantly associated with the development of post-traumatic stress symptoms. Conclusions: Our data suggest a high incidence of post-traumatic stress disorder in Italian residents working in Intensive Care Units and Emergency Departments during the SARS-CoV-2 outbreak. This finding supports the importance of promptly implementing any strategy that might preserve staff mental health. (www.actabiomedica.it)
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Affiliation(s)
| | - Nicolò Sella
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Christelle Correale
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Annalisa Boscolo
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Giulia Mormando
- Department of Medicine (DIMED), University of Padova, Italy.
| | - Maria Zordan
- Department of Mental Health, Azienda ULSS 7 Pedemontana.
| | | | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padova, Italy.
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Cai Q, Feng H, Huang J, Wang M, Wang Q, Lu X, Xie Y, Wang X, Liu Z, Hou B, Ouyang K, Pan J, Li Q, Fu B, Deng Y, Liu Y. The mental health of frontline and non-frontline medical workers during the coronavirus disease 2019 (COVID-19) outbreak in China: A case-control study. J Affect Disord 2020; 275:210-215. [PMID: 32734910 PMCID: PMC7329671 DOI: 10.1016/j.jad.2020.06.031] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Coronavirus disease 2019 (COVID-19) is a new infectious disease with high transmissibility and morbidity. It has caused substantial mental distress to medical professionals. We aimed to compare the psychological impact of the COVID-19 outbreak between frontline and non-frontline medical workers in China. METHODS This case-control study recruited 1173 frontline and 1173 age- and sex-matched non-frontline medical workers during the COVID-19 outbreak (February 11 to 26, 2020). A set of online questionnaires were used to measure mental problems (i.e., anxiety, insomnia, and depressive symptoms), and help-seeking behavior and treatment for these mental problems. RESULTS Frontline medical workers had higher rates of any mental problem (52.6% vs. 34.0%, adjusted OR=1.88, 95% CI=1.57-2.25), anxiety symptoms (15.7% vs. 7.4%, adjusted OR=1.95, 95% CI=1.46-2.61), depressed mood (marginally insignificant; 14.3% vs. 10.1%, adjusted OR=1.32, 95% CI=0.99-1.76) and insomnia (47.8% vs. 29.1%, adjusted OR=1.96, 95% CI=1.63-2.36) than non-frontline medical workers. No significant difference was observed in terms of suicidal ideation (12.0% vs. 9.0%, adjusted OR=1.25, 95% CI=0.92-1.71), help-seeking (4.5% vs. 4.5%, adjusted OR=1.00, 95% CI=0.53-1.87) or treatment (3.4% vs. 2.3%, adjusted OR=1.38, 95% CI=0.54-3.52) for mental problems. LIMITATIONS The case-control nature of the data precludes causal inferences, and there is a possibility of bias related to self-reports. CONCLUSIONS Frontline medical workers had more mental problems but comparable help-seeking behaviors and treatment for these problems than non-frontline medical workers. These findings highlight the timely mental support and intervention for medical workers, especially for those on the frontline.
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Affiliation(s)
- Qi Cai
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Hongliang Feng
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jing Huang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Meiyao Wang
- Department of Ultrasonography, Zhongnan hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - Qunfeng Wang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China; Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Xuanzhen Lu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Yu Xie
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Xing Wang
- Department of Neurology, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhenxing Liu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Botong Hou
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Keni Ouyang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Jing Pan
- Department of Infectious Diseases, Xiaogan hospital affiliated to Wuhan university of science and technology, Xiaogan, Hubei, PR China
| | - Qin Li
- Department of Neurology, The Third people's hospital of Hubei province Affiliated to Wuhan University, Wuhan, Hubei, PR China
| | - Beibei Fu
- Department of Neurology, Shiyan people's hospital, Hubei University of Medicine, ShiYan, Hubei, PR China
| | - Yongchao Deng
- Department of Neurology, The second people's hospital of Jingzhou, Jingzhou, Hubei, PR China
| | - Yumin Liu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China.
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Sakuma A, Ueda I, Shoji W, Tomita H, Matsuoka H, Matsumoto K. Trajectories for Post-traumatic Stress Disorder Symptoms Among Local Disaster Recovery Workers Following the Great East Japan Earthquake: Group-based Trajectory Modeling. J Affect Disord 2020; 274:742-751. [PMID: 32664010 PMCID: PMC7261355 DOI: 10.1016/j.jad.2020.05.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms. METHODS The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated. RESULTS We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences. LIMITATIONS Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area. CONCLUSIONS The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters.
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Affiliation(s)
- Atsushi Sakuma
- Department of Psychiatry, Tohoku University Hospital; Miyagi Disaster Mental Health Care Center.
| | - Ikki Ueda
- Department of Psychiatry, Tohoku University Hospital,Miyagi Disaster Mental Health Care Center
| | - Wataru Shoji
- Department of Human Science, Faculty of Liberal Arts, Tohoku Gakuin University,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine
| | - Hiroaki Tomita
- Miyagi Disaster Mental Health Care Center,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine,Department of Psychiatry, Tohoku University Graduate School of Medicine
| | - Hiroo Matsuoka
- Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine
| | - Kazunori Matsumoto
- Miyagi Disaster Mental Health Care Center,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine,Department of Psychiatry, Tohoku University Graduate School of Medicine
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Hamwey MK, Gargano LM, Friedman LG, Leon LF, Petrsoric LJ, Brackbill RM. Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4344. [PMID: 32560511 PMCID: PMC7344905 DOI: 10.3390/ijerph17124344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.
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Affiliation(s)
| | | | | | | | | | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (M.K.H.); (L.M.G.); (L.G.F.); (L.F.L.); (L.J.P.)
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Tai YM, Lin MW, Tsai CW, Hsu CC, Kao LC, Yang SN. Critical incident stress debriefing for frontline military rescuers in a helicopter crash disaster in Taiwan: A preliminary report. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Bentz L, Pirard P, Motreff Y, Vandentorren S, Baubet T, Fabre R, Touboul Lundgren P, Pradier C. Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice » health survey protocol. BMC Public Health 2019; 19:1163. [PMID: 31443708 PMCID: PMC6708198 DOI: 10.1186/s12889-019-7489-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered. METHOD ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data. DISCUSSION The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.
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Affiliation(s)
- Laurence Bentz
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.
| | - Philippe Pirard
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France
| | - Yvon Motreff
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France
| | - Stéphanie Vandentorren
- Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France.,French National Public Health Agency (Santé Publique France), Regional Office of Nouvelle Aquitaine, F-94415, Saint-Maurice, France
| | - Thierry Baubet
- Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France.,Paris-Seine-Saint-Denis University Hospitals (AP-HP), Hôpital Avicenne, Paris 13 University, F-93000, Bobigny, France.,National Resources and Resilience Centre (CNRR), F-93000, Bobigny, France
| | - Roxane Fabre
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.,CoBTeK lab, Nice University Hospital, CMRR, Cote d'Azur University, F-06200, Nice, France
| | - Pia Touboul Lundgren
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
| | - Christian Pradier
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
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Posttraumatic Stress Disorder and Mental Distress Following the 2004 and 2005 Florida Hurricanes. Disaster Med Public Health Prep 2019; 13:44-52. [PMID: 30616708 DOI: 10.1017/dmp.2018.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons. METHODS Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher. RESULTS In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96). CONCLUSIONS Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44-52).
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Lowell A, Suarez-Jimenez B, Helpman L, Zhu X, Durosky A, Hilburn A, Schneier F, Gross R, Neria Y. 9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack. Psychol Med 2018; 48:537-553. [PMID: 28805168 PMCID: PMC5805615 DOI: 10.1017/s0033291717002033] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited. METHODS The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies. RESULTS Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies. CONCLUSION Future directions for research, treatment, and healthcare policy are discussed.
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Affiliation(s)
- A. Lowell
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - B. Suarez-Jimenez
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - L. Helpman
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - X. Zhu
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - A. Durosky
- New York State Psychiatric Institute, New York, NY, USA
| | - A. Hilburn
- New York State Psychiatric Institute, New York, NY, USA
| | - F. Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - R. Gross
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y. Neria
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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15
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Effects of Disaster Damage and Working Conditions on Mental Health Among Public Servants 16 Months After the Great East Japan Earthquake. Disaster Med Public Health Prep 2018; 12:622-630. [PMID: 29444742 DOI: 10.1017/dmp.2017.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore whether stressors after a disaster have later effects on the mental health of public servants who engage in disaster response and to estimate the proportion of those experiencing persistent mental distress. METHODS We analyzed the data of health surveys conducted in Miyagi Prefecture for all prefectural public servants at 2, 7, and 16 months after the Great East Japan Earthquake (n=3174). We investigated relationships between mental distress (defined as K6≥10) at 16 months after the earthquake and earthquake damage and working conditions at 2 months. We also calculated the proportion of participants who scored K6≥10 on all 3 surveys. RESULTS The experience of living someplace other than one's own home was significantly related with mental distress at 16 months after the earthquake. Few participants consistently scored K6≥10 throughout all 3 surveys. CONCLUSIONS The effects of stressors in the aftermath of a disaster could remain for a long time. Few public servants experienced persistent mental distress. Disaster Med Public Health Preparedness. 2018;12:622-630.
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Lee MS, Bhang SY, Lee CS, Chang HY, Kim JY, Lee JH, Kim E, Bae SM, Park JH, Kim HJ, Hwang JW. Psychiatric Symptoms in Teachers from Danwon High School after Exposure to the Sinking of the Motor Vessel Sewol. Psychiatry Investig 2017; 14:900-903. [PMID: 29209399 PMCID: PMC5714737 DOI: 10.4306/pi.2017.14.6.900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/11/2017] [Accepted: 01/29/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The goal of this study was to describe the psychiatric symptoms in the teachers from Danwon High School who were exposed to the sinking of the Motor Vessel Sewol. METHODS Data were collected from 32 teachers who underwent psychiatric interventions by 16 volunteer psychiatrists for 3 months after the sinking of the Motor Vessel Sewol. RESULTS The most commonly diagnosed clinical diagnosis in the teachers were normal reaction, acute stress disorder and adjustment disorder. Psychiatric symptoms including anxiety, depressed mood and sleep disturbances were also observed. CONCLUSION In the acute aftermath of the Sewol Ferry sinking on April 16, 2014, psychiatrists volunteered to provide professional psychiatric interventions to Danwon High School teachers. These results suggest the importance of crisis intervention focused on the teachers who are exposed to disasters. The implications for future research and interventions are discussed.
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Affiliation(s)
- Mi-Sun Lee
- Department of Psychiatry, Eulji University Hospital, Seoul, Republic of Korea
| | - Soo-Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Seoul, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyoung Yoon Chang
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
- Sunflower Center of Southern Gyeonggi for Women and Children Victims of Violence, Suwon, Republic of Korea
| | - Ji-Youn Kim
- Goodmind Psychiatry Clinic, Suwon, Republic of Korea
| | - Ju-Hyun Lee
- Inarae Psychiatry Clinic, Seoul, Republic of Korea
| | - Eunji Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seung-Min Bae
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jang-Ho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hye-Jin Kim
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jun-Won Hwang
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
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Mindlis I, Morales-Raveendran E, Goodman E, Xu K, Vila-Castelar C, Keller K, Crawford G, James S, Katz CL, Crowley LE, de la Hoz RE, Markowitz S, Wisnivesky JP. Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers. J Asthma 2017; 54:723-731. [PMID: 27905829 PMCID: PMC9318000 DOI: 10.1080/02770903.2016.1263650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.
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Affiliation(s)
- I. Mindlis
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E. Morales-Raveendran
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E. Goodman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K. Xu
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C. Vila-Castelar
- The Graduate Center, City University of New York, New York, NY, USA
- Queens College, City University of New York, Flushing, NY, USA
| | - K. Keller
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G. Crawford
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S. James
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C. L. Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L. E. Crowley
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R. E. de la Hoz
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S. Markowitz
- Queens College, City University of New York, Flushing, NY, USA
| | - J. P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lee JY, Kim SW, Bae KY, Kim JM, Shin IS, Yoon JS. Factors associated with posttraumatic stress disorder symptoms among community volunteers during the Sewol ferry disaster in Korea. Compr Psychiatry 2017; 77:38-44. [PMID: 28605622 DOI: 10.1016/j.comppsych.2017.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/01/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the characteristics associated with volunteerism and identify the factors that contributed to posttraumatic stress disorder symptoms among community volunteers following the Sewol ferry disaster in Korea. METHODS In total, 2,298 adults (aged 30-70 years) from the Jin-do area, where the Sewol ferry disaster occurred, participated in this study. A cross-sectional survey was conducted 1 month after the disaster. Posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were assessed using the Impact of Events Scale Revised (IES-R), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Anxiety Inventory (BAI). RESULTS Clinically relevant PTSD symptoms were observed in 151 (19.7%) community volunteers. Age, education, socioeconomic status, religion, and lifetime experiences of natural disasters were associated with volunteering following the disaster. Logistic regression analysis revealed that volunteering was a significant risk factor for the development of PTSD symptoms in this sample. Personal experience with property damage associated with a traumatic event, depression, and anxiety were also significantly associated with the PTSD symptoms of community volunteers. CONCLUSIONS Our results suggest the need for assessment and mental health programs for community volunteers performing rescue work to prevent posttraumatic stress symptoms following a community disaster.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Conduct of Occupational Health During Major Disasters: A Comparison of Literature on Occupational Health Issues in the World Trade Center Terrorist Attack and the Fukushima Nuclear Power Plant Accident. J UOEH 2017. [PMID: 28626126 DOI: 10.7888/juoeh.39.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Workers who respond to large-scale disasters can be exposed to health hazards that do not exist in routine work. It is assumed that learning from past cases is effective for preparing for and responding to such problems, but published information is still insufficient. Accordingly, we conducted a literature review about the health issues and occupational health activities at the World Trade Center (WTC) terrorist attack and at the Fukushima Nuclear Power Plant accident to investigate how occupational health activities during disasters should be conducted. Seven studies about the WTC attack were extracted and categorized into the following topics: "in relation to emergency systems including occupational health management"; "in relation to improvement and prevention of health effects and occupational hygiene"; and "in relation to care systems aimed at mitigating health effects." Studies about the Fukushima Nuclear Power Plant accident have been used in a previous review. We conclude that, to prevent health effects in workers who respond to large-scale disasters, it is necessary to incorporate occupational health regulations into the national response plan, and to develop practical support functions that enable support to continue for an extended period, training systems for workers with opportunities to report accidents, and care systems to mitigate the health effects.
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Lee K, Lee SH, Park T, Lee JY. Stressors of Korean Disaster Relief Team Members during the Nepal Earthquake Dispatch: a Consensual Qualitative Research Analysis. J Korean Med Sci 2017; 32:507-513. [PMID: 28145656 PMCID: PMC5290112 DOI: 10.3346/jkms.2017.32.3.507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022] Open
Abstract
We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.
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Affiliation(s)
- Kangeui Lee
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea.
| | - Taejin Park
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Ji Yeon Lee
- Graduate School of Education, Hankuk University of Foreign Studies, Seoul, Korea
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Supporting Community Health Workers After a Disaster: Findings From a Mixed-Methods Pilot Evaluation Study of a Psychoeducational Intervention. Disaster Med Public Health Prep 2016; 10:754-761. [PMID: 27349586 DOI: 10.1017/dmp.2016.40] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Community health workers (CHWs) in disaster-affected areas are at risk for emotional distress, as they support others while they may be in the process of rebuilding their own lives. The Resilience and Coping for the Healthcare Community (RCHC) intervention was developed in response to the stress CHWs faced after Hurricane Sandy. The intervention uses psychoeducation to help participants identify common stress responses, recognize signs of job burnout, and utilize healthy coping strategies. METHODS A mixed-methods pilot of the RCHC intervention was conducted in 2013 with a convenience sample of staff from 6 federally qualified health centers (n=69). Validated measures of stress, coping, compassion fatigue and satisfaction, burnout, stress, and social provisions and a measure of perceived knowledge were administered at baseline, after the workshop, and at a 3-week follow-up. Semi-structured interviews were conducted with 10 randomly selected participants and were analyzed by using content analysis. RESULTS From baseline to the post-workshop assessment, perceived knowledge scores increased from 24.59 to 30.34, t(62)=5.16 (P<0.001), and acute stress scores decreased significantly from 10.53 to 6.78, t(64)=4.74 (P<0.001). Significant increases from baseline to the 3-week follow-up (n=45) were found for perceived knowledge (24.05 to 27.24; t(40)=5.37; P<0.001), and social provisions (27.34 to 28.39; t(44)=2.15; P<0.05). CONCLUSIONS Our qualitative findings indicated that the respondents valued learning about common stress responses and incorporating coping as part of a daily routine. Team building and normalization of emotions were seen as ancillary benefits that would reduce stress levels in the workplace. In conclusion, the RCHC intervention shows promise and should be investigated further in experimental studies. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).
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Johal SS, Mounsey ZR. Recovering from disaster: Comparing the experiences of nurses and general practitioners after the Canterbury, New Zealand earthquake sequence 2010-2011. Nurs Health Sci 2016; 19:29-34. [DOI: 10.1111/nhs.12296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Zoe Rachel Mounsey
- Joint Centre for Disaster Research; Massey University/GNS Science; Wellington New Zealand
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Skogstad L, Heir T, Hauff E, Ekeberg Ø. Post-traumatic stress among rescue workers after terror attacks in Norway. Occup Med (Lond) 2016; 66:528-35. [PMID: 27325417 DOI: 10.1093/occmed/kqw063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. AIMS To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). METHODS A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. RESULTS There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (β = 1.7), witnessing injured/dead (β = 2.0), perceived threat (β = 1.1), perceived obstruction in rescue work (β = 1.6), lower degree of previous training (β = -0. 9) and being unaffiliated volunteers (β = 8.3) were significantly associated with PTSS. CONCLUSIONS In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.
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Affiliation(s)
- L Skogstad
- Research and Development, Department of Acute Medicine, Oslo University Hospital, 0424 Oslo, Norway, Paramedic Sciences, Oslo and Akershus University College, 0130 Oslo, Norway,
| | - T Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
| | - E Hauff
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Ø Ekeberg
- Research and Development, Department of Acute Medicine, Oslo University Hospital, 0424 Oslo, Norway, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway, Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
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Gjerland A, Pedersen MJB, Ekeberg Ø, Skogstad L. Sick-leave and help seeking among rescue workers after the terror attacks in Norway, 2011. Int J Emerg Med 2015; 8:81. [PMID: 26283071 PMCID: PMC4539308 DOI: 10.1186/s12245-015-0081-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have addressed psychological problems after terror attacks, especially among victims. Fewer have addressed possible health consequences among rescue workers involved with terror attacks. This study's aim was to investigate the levels of sick-leave and psychological help seeking among rescue workers involved in the terror attacks in Norway on July 22, 2011, and to identify associations between sick-leave and background-, exposure- and work-related variables. METHODS This cross-sectional study included five groups of professional rescue personnel and one group of unaffiliated volunteers. The questionnaire was distributed approximately 10 months after the terror attacks, with a response rate of 61.3 % (N = 1790). RESULTS A total of 9.7 % of participants self-reported sick-leave. The rate varied from 2.4 % among police officers to 14.5 % among unaffiliated volunteers, p < .001. There were 0.0-1.2 % of the professionals who were on sick-leave for more than 2 weeks and 5.5 % among the unaffiliated volunteers. More unaffiliated volunteers (42.6 %) and psychosocial personnel (16.3 %) consulted a psychologist or psychiatrist compared to other groups (3-9 %), p < .001. General healthcare providers (OR 6.1), psychosocial personnel (OR 6.3) and unaffiliated volunteers (OR 5.7) were associated with sick-leave, together with unwanted stress reactions (OR 1.6) and starting work on July 22 (OR 1.6). CONCLUSIONS A small minority of professional rescue workers reported sick-leave for more than 2 weeks, and few had sought psychological help. Unaffiliated volunteers reported more stress symptoms, longer sick-leave duration and more psychological help seeking. This group may benefit from more support.
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Affiliation(s)
- Astrid Gjerland
- Department of Anesthesia, Intensive, Operation and Emergency, Baerum Hospital, Vestre Viken Hospital Trust, Drammen, Norway,
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Relationships between mental health distress and work-related factors among prefectural public servants two months after the Great East Japan Earthquake. Int J Behav Med 2015; 22:1-10. [PMID: 24585179 DOI: 10.1007/s12529-014-9392-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In times of disaster, public servants face multiple burdens as they engage in a demanding and stressful disaster-response work while managing their own needs caused by the disaster. PURPOSE We investigated the effects of work-related factors on the mental health of prefectural public servants working in the area devastated by the Great East Japan Earthquake to identify some ideas for organizational work modifications to protect their mental health. METHODS Two months after the earthquake, Miyagi prefecture conducted a self-administered health survey of prefectural public servants and obtained 4,331 (82.8%) valid responses. We investigated relationships between mental health distress (defined as K6 ≥ 13) and work-related variables (i.e., job type, overwork, and working environment) stratified by level of earthquake damage experienced. RESULTS The proportion of participants with mental health distress was 3.0% in the group that experienced less damage and 5.9% in the group that experienced severe damage. In the group that experienced less damage, working >100 h of overtime per month (adjusted odds ratio [OR], 2.06; 95% confidence interval [CI], 1.11-3.82) and poor workplace communication (adjusted OR, 10.96; 95% CI, 6.63-18.09) increased the risk of mental health distress. In the group that experienced severe damage, handling residents' complaints (adjusted OR, 4.79; 95% CI, 1.55-14.82) and poor workplace communication (adjusted OR, 9.14; 95% CI, 3.34-24.97) increased the risk, whereas involvement in disaster-related work (adjusted OR, 0.39; 95% CI, 0.18-0.86) decreased the risk. CONCLUSIONS Workers who have experienced less disaster-related damage might benefit from working fewer overtime hours, and those who have experienced severe damage might benefit from avoiding contact with residents and engaging in disaster-related work. Facilitating workplace communication appeared important for both groups of workers.
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Maslow CB, Caramanica K, Welch AE, Stellman SD, Brackbill RM, Farfel MR. Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers. J Trauma Stress 2015; 28:198-205. [PMID: 25990986 DOI: 10.1002/jts.22011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.
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Affiliation(s)
- Carey B Maslow
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Alice E Welch
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
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Disaster-related exposures and health effects among US Coast Guard responders to Hurricanes Katrina and Rita: a cross-sectional study. J Occup Environ Med 2015; 56:820-33. [PMID: 25099408 DOI: 10.1097/jom.0000000000000188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Disaster responders work among poorly characterized physical and psychological hazards with little understood regarding health consequences of their work. METHODS A survey administered to 2834 US Coast Guard responders to Hurricanes Katrina and Rita provided data on exposures and health effects. Prevalence odds ratios (PORs) evaluated associations between baseline characteristics, missions, exposures, and health effects. RESULTS Most frequent exposures were animal/insect vector (n = 1309; 46%) and floodwater (n = 817; 29%). Most frequent health effects were sunburn (n = 1119; 39%) and heat stress (n = 810; 30%). Significant positive associations were for mold exposure and sinus infection (POR = 10.39); carbon monoxide and confusion (POR = 6.27); lack of sleep and slips, trips, falls (POR = 3.34) and depression (POR = 3.01); being a Gulf-state responder and depression (POR = 3.22). CONCLUSIONS Increasing protection for disaster responders requires provisions for adequate sleep, personal protective equipment, and access to medical and psychological support.
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Sakuma A, Takahashi Y, Ueda I, Sato H, Katsura M, Abe M, Nagao A, Suzuki Y, Kakizaki M, Tsuji I, Matsuoka H, Matsumoto K. Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake: a cross-sectional study. BMC Psychiatry 2015; 15:58. [PMID: 25879546 PMCID: PMC4374405 DOI: 10.1186/s12888-015-0440-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many local workers have been involved in rescue and reconstruction duties since the Great East Japan Earthquake (GEJE) on March 11, 2011. These workers continuously confront diverse stressors as both survivors and relief and reconstruction workers. However, little is known about the psychological sequelae among these workers. Thus, we assessed the prevalence of and personal/workplace risk factors for probable post-traumatic stress disorder (PTSD), probable depression, and high general psychological distress in this population. METHODS Participants (N = 1294; overall response rate, 82.9%) were workers (firefighters, n = 327; local municipality workers, n = 610; hospital medical workers, n = 357) in coastal areas of Miyagi prefecture. The study was cross-sectional and conducted 14 months after the GEJE using a self-administered questionnaire which included the PTSD Checklist-Specific Version, the Patient Health Questionnaire-9, and the K6 scale. Significant risk factors from bivariate analysis, such as displacement, dead or missing family member(s), near-death experience, disaster related work, lack of communication, and lack of rest were considered potential factors in probable PTSD, probable depression, and high general psychological distress, and were entered into the multivariable logistic regression model. RESULTS The prevalence of probable PTSD, probable depression, and high general psychological distress was higher among municipality (6.6%, 15.9%, and 14.9%, respectively) and medical (6.6%, 14.3%, and 14.5%, respectively) workers than among firefighters (1.6%, 3.8%, and 2.6%, respectively). Lack of rest was associated with increased risk of PTSD and depression in municipality and medical workers; lack of communication was linked to increased PTSD risk in medical workers and depression in municipality and medical workers; and involvement in disaster-related work was associated with increased PTSD and depression risk in municipality workers. CONCLUSIONS The present results indicate that at 14 months after the GEJE, mental health consequences differed between occupations. High preparedness, early mental health interventions, and the return of ordinary working conditions might have contributed to the relative mental health resilience of the firefighters. Unlike the direct effects of disasters, workplace risk factors can be modified after disasters; thus, we should develop countermeasures to improve the working conditions of local disaster relief and reconstruction workers.
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Affiliation(s)
- Atsushi Sakuma
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan.
| | - Yoko Takahashi
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ikki Ueda
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Hirotoshi Sato
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan.
| | - Masahiro Katsura
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan.
| | - Mikika Abe
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ayami Nagao
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Yuriko Suzuki
- Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Masako Kakizaki
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Hiroo Matsuoka
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Kazunori Matsumoto
- Miyagi Disaster Mental Health Care Center, 2-18-21 Honcho, Aoba-ku, Sendai, Miyagi, 980-0014, Japan. .,Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Abstract
Mortuary workers are at high risk of developing depression and other psychiatric disorders owing to the nature of their work and exposure to deceased victims of violent deaths. Few studies have investigated mental health among mortuary workers in low- and middle-income countries. Participants (N = 45) were recruited from mortuaries in South Africa and completed a battery of questionnaires measuring depression, physical health, perceived stress, fear of blood/injury/mutilation, and resilience. Participants with self-reported depression and posttraumatic stress disorder (PTSD) comprised 13.3% and 4.4% of the sample, respectively. Inexperienced mortuary workers had a higher prevalence rate of depression (16.7%) compared with experienced workers (9.5%). Prevalence of PTSD did not differ significantly between inexperienced (4.2%) and experienced (4.8%) workers. Physical health, perceived stress, fear of blood/injury/mutilation, and resilience were significant predictors of depression in the combined group (experienced and inexperienced). However, perceived stress was the only significant predictor of depression, in multiple regression, in the combined group. Inexperienced workers had significantly higher levels of blood/injury/mutation fear and depression. Mortuary workers seem to be at increased risk of depression, especially inexperienced workers. Perceived poor health, lower levels of resilience, and blood/injury/mutilation fears may lead to increased perceived stress among mortuary workers, which may, in turn, lead to depression. Interventions focused on promoting mental health may be beneficial to all mortuary workers, and preparatory training related to mental health may be beneficial to inexperienced mortuary workers before occupational uptake.
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Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes. Disaster Med Public Health Prep 2014; 7:89-95. [PMID: 24618140 DOI: 10.1017/dmp.2013.6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We examined the relationship of probable posttraumatic stress disorder (PTSD), probable depression, and increased alcohol and/or tobacco use to disaster exposure and work demand in Florida Department of Health workers after the 2004 hurricanes. METHODS Participants (N = 2249) completed electronic questionnaires assessing PTSD, depression, alcohol and tobacco use, hurricane exposure, and work demand. RESULTS Total mental and behavioral health burden (probable PTSD, probable depression, increased alcohol and/or tobacco use) was 11%. More than 4% had probable PTSD, and 3.8% had probable depression. Among those with probable PTSD, 29.2% had increased alcohol use, and 50% had increased tobacco use. Among those with probable depression, 34% indicated increased alcohol use and 55.6% increased tobacco use. Workers with greater exposure were more likely to have probable PTSD and probable depression (ORs = 3.3 and 3.06, respectively). After adjusting for demographics and work demand, those with high exposure were more likely to have probable PTSD and probable depression (ORs = 3.21 and 3.13). Those with high exposure had increased alcohol and tobacco use (ORs = 3.01 and 3.40), and those with high work demand indicated increased alcohol and tobacco use (ORs = 1.98 and 2.10). High exposure and work demand predicted increased alcohol and tobacco use, after adjusting for demographics, work demand, and exposure. CONCLUSIONS Work-related disaster mental and behavioral health burden indicate the need for additional mental health interventions in the public health disaster workforce.
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Longitudinal study of the impact of psychological distress symptoms on new-onset upper gastrointestinal symptoms in World Trade Center responders. Psychosom Med 2014; 76:686-93. [PMID: 25373890 DOI: 10.1097/psy.0000000000000116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Research on the health of workers involved in the cleanup after the attack on the World Trade Center (WTC) on September 11, 2001, has documented high rates of psychological distress and upper gastrointestinal (GI) symptoms. The current article examines the concurrent and longitudinal associations of psychological distress with development of new-onset upper GI symptoms in a large sample of WTC responders. METHODS A cohort of 10,953 WTC responders monitored by the WTC Health Program participated in the study. Two occupational groups were examined, police and nontraditional responders. The cohort was free of upper GI symptoms or diagnoses at their first visit (3 years after September 11, 2001). Logistic regression was used to analyze the relationships between concurrent and preceding psychological distress symptoms of depression, generalized anxiety, panic, and probable posttraumatic stress disorder with the development of new-onset upper GI symptoms at 3-year follow-up (6 years after September 11, 2001). RESULTS Across both occupation groups, psychological distress symptoms at Visit 1 were significantly related to the development of GI symptoms by Visit 2 (odd ratios ranging from 1.9 to 5.4). The results for the concurrent relationships were similar. In addition, there were significant dose-response relationships between the number of co-occurring psychological distress symptoms at Visits 1 and 2, and increased new-onset upper GI symptoms at Visit 2. CONCLUSIONS In this large sample of WTC responders, psychological distress symptoms assessed at 3 years after 9/11 are related to reporting upper GI symptoms 6 years after 9/11.
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Abstract
Research links air pollution mostly to respiratory and cardiovascular disease. The effects of air pollution on the central nervous system (CNS) are not broadly recognized. Urban outdoor pollution is a global public health problem particularly severe in megacities and in underdeveloped countries, but large and small cities in the United States and the United Kingom are not spared. Fine and ultrafine particulate matter (UFPM) defined by aerodynamic diameter (<2.5-μm fine particles, PM2.5, and <100-nm UFPM) pose a special interest for the brain effects given the capability of very small particles to reach the brain. In adults, ambient pollution is associated to stroke and depression, whereas the emerging picture in children show significant systemic inflammation, immunodysregulation at systemic, intratechal and brain levels, neuroinflammation and brain oxidative stress, along with the main hallmarks of Alzheimer and Parkinson's diseases: hyperphosphorilated tau, amyloid plaques and misfolded α-synuclein. Animal models exposed to particulate matter components show markers of both neuroinflammation and neurodegeneration. Epidemiological, cognitive, behavioral and mechanistic studies into the association between air pollution exposures and the development of CNS damage particularly in children are of pressing importance for public health and quality of life. Primary health providers have to include a complete prenatal and postnatal environmental and occupational history to indoor and outdoor toxic hazards and measures should be taken to prevent or reduce further exposures.
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Thompson J, Rehn M, Lossius HM, Lockey D. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:521. [PMID: 25323086 PMCID: PMC4422304 DOI: 10.1186/s13054-014-0521-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.
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Affiliation(s)
- Julian Thompson
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - Hans Morten Lossius
- Department of Research and Development, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway. .,Field of Pre-hospital Critical Care, Network of Medical Sciences, University of Stavanger, Kjel Aarholmsgate 41, 4036, Stavanger, Norway.
| | - David Lockey
- London's Air Ambulance, The Helipad, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK. .,School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK.
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Liu B, Tarigan LH, Bromet EJ, Kim H. World Trade Center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: a meta-analysis. PLoS One 2014; 9:e101491. [PMID: 25047411 PMCID: PMC4105417 DOI: 10.1371/journal.pone.0101491] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/08/2014] [Indexed: 01/06/2023] Open
Abstract
The World Trade Center (WTC) disaster on September 11, 2001 was an unprecedented traumatic event with long-lasting health consequences among the affected populations in the New York metropolitan area. This meta-analysis aimed to estimate the risk of probable posttraumatic stress disorder (PTSD) associated with specific types of WTC exposures. Meta-analytical findings from 10 studies of 3,271 to 20,294 participants yielded 37 relevant associations. The pooled summary odds ratio (OR) was 2.05 (95% confidence interval (CI): 1.82, 2.32), with substantial heterogeneity linked to exposure classification, cohort type, data source, PTSD assessment instrument/criteria, and lapse time since 9/11. In general, responders (e.g. police, firefighters, rescue/recovery workers and volunteers) had a lower probable PTSD risk (OR = 1.61; 95% CI: 1.39, 1.87) compared to civilians (e.g. residents, office workers, and passersby; OR = 2.71, 95% CI: 2.35, 3.12). The differences in ORs between responders and civilians were larger for physical compared to psychosocial exposure types. We also found that injury, lost someone, and witnessed horror were the three (out of six) most pernicious exposures. These findings suggest that these three exposures should be a particular focus in psychological evaluation and treatment programs in WTC intervention and future emergency preparedness efforts.
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Affiliation(s)
- Bian Liu
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
- * E-mail:
| | - Lukman H. Tarigan
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Evelyn J. Bromet
- Department of Psychiatry and Behavioral Science, State University of New York-Stony Brook, Stony Brook, New York, United States of America
| | - Hyun Kim
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
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Suzuki Y, Fukasawa M, Obara A, Kim Y. Mental health distress and related factors among prefectural public servants seven months after the great East Japan Earthquake. J Epidemiol 2014; 24:287-94. [PMID: 24857952 PMCID: PMC4074633 DOI: 10.2188/jea.je20130138] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To develop an empirically informed support measure for workers, we examined mental health distress and its risk factors among prefectural public servants who were affected by the Great East Japan Earthquake and faced a demanding workload in the midterm of the disaster. METHODS We conducted a self-administered health survey of all public servants in the Miyagi prefectural government two and seven months after the Great East Japan Earthquake (3743 workers, 70.6% of all employees). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for mental distress (defined as K6 score ≥10) in the domain of disaster-work-related stressors, work-related stressors, and disaster-related stressors. RESULTS Among those with better levels of workplace communication, the only factor that increased the risk of mental distress was not taking a non-work day each week (adjusted OR 2.55, 95% CI 1.27-5.14). Among those with poorer levels of workplace communication, in addition to not taking a non-work day each week (adjusted OR 3.93, 95% CI 3.00-5.15), handling residents' complaints (adjusted OR 1.55, 95% CI 1.00-2.42), having dead or missing family members (adjusted OR 2.87, 95% CI 1.53-5.38), and living in a shelter more than two months after the disaster (adjusted OR 2.80, 95% CI 1.32-5.95) increased the risk of mental distress. CONCLUSIONS All workers should be encouraged to take a non-work day each week. Among workers with poor workplace communication, special attention should be given to those who handle residents' complaints, have lost a family member(s), and are living in a shelter for a prolonged period of time.
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Affiliation(s)
- Yuriko Suzuki
- Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry
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Posttraumatic stress disorder and community collective efficacy following the 2004 Florida hurricanes. PLoS One 2014; 9:e88467. [PMID: 24523900 PMCID: PMC3921167 DOI: 10.1371/journal.pone.0088467] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
Abstract
There is a paucity of research investigating the relationship of community-level characteristics such as collective efficacy and posttraumatic stress following disasters. We examine the association of collective efficacy with probable posttraumatic stress disorder and posttraumatic stress disorder symptom severity in Florida public health workers (n = 2249) exposed to the 2004 hurricane season using a multilevel approach. Anonymous questionnaires were distributed electronically to all Florida Department of Health personnel nine months after the 2004 hurricane season. The collected data were used to assess posttraumatic stress disorder and collective efficacy measured at both the individual and zip code levels. The majority of participants were female (80.42%), and ages ranged from 20 to 78 years (median = 49 years); 73.91% were European American, 13.25% were African American, and 8.65% were Hispanic. Using multi-level analysis, our data indicate that higher community-level and individual-level collective efficacy were associated with a lower likelihood of having posttraumatic stress disorder (OR = 0.93, CI = 0.88-0.98; and OR = 0.94, CI = 0.92-0.97, respectively), even after adjusting for individual sociodemographic variables, community socioeconomic characteristic variables, individual injury/damage, and community storm damage. Higher levels of community-level collective efficacy and individual-level collective efficacy were also associated with significantly lower posttraumatic stress disorder symptom severity (b = -0.22, p<0.01; and b = -0.17, p<0.01, respectively), after adjusting for the same covariates. Lower rates of posttraumatic stress disorder are associated with communities with higher collective efficacy. Programs enhancing community collective efficacy may be an important part of prevention practices and possibly lead to a reduction in the rate of posttraumatic stress disorder post-disaster.
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Assessing postdisaster psychological stress in hazardous waste operations and emergency response (HAZWOPER) workers. Disaster Med Public Health Prep 2013; 7:452-60. [PMID: 24274124 DOI: 10.1017/dmp.2013.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the prevalence of traumatic stress experienced by secondary responders to disaster events to determine if mental health education should be included in HAZWOPER training. METHODS Preexisting survey tools for assessing posttraumatic stress disorder (PTSD), resiliency, and mental distress were combined to form a web-based survey tool that was distributed to individuals functioning in secondary response roles. Data were analyzed using the Fisher exact test, 1-way ANOVA, and 1-sample t tests. RESULTS Respondents reported elevated PTSD levels (32.9%) as compared to the general population. HAZWOPER-trained responders with disaster work experience were more likely to be classified as PTSD positive as compared to untrained, inexperienced responders and those possessing only training or experience. A majority (68.75%) scored below the mean resiliency level of 80.4 on the Connor-Davidson Resilience Scale. Respondents with only training or both training and experience were more likely to exhibit lower resiliency scores than those with no training or experience. PTSD positivity correlated with disaster experience. Among respondents, 91% indicated support for mental health education. CONCLUSIONS Given the results of the survey, consideration should be given to the inclusion of pre- and postdeployment mental health education in the HAZWOPER training regimen.
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McKibben JBA, Fullerton CS, Ursano RJ, Reissman DB, Kowalski-Trakofler K, Shultz JM, Wang L. Sleep and arousal as risk factors for adverse health and work performance in public health workers involved in the 2004 Florida hurricane season. Disaster Med Public Health Prep 2013; 4 Suppl 1:S55-62. [PMID: 23105036 DOI: 10.1001/dmp.2010.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season. METHODS FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand. RESULTS More than 18% of FDOH employees reported ≥ 25% reduced work performance and 11% to 15.3% reported ≥ 7 "bad" mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), "bad" mental health (ORs 3.01 and 3.64), "bad" physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32), even after adjusting for sex, race, age, education, and marital status. CONCLUSIONS Among public health workers exposed to the 2004 hurricanes, sleep disturbance and arousal were associated with personal and work impairment. Future research should continue to examine the effect of repeated exposure to disasters in first responders.
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Affiliation(s)
- Jodi B A McKibben
- Center for the Study of Traumatic Stress, Dept of Psychiatry,Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Kitamura H, Shindo M, Tachibana A, Honma H, Someya T. Personality and Resilience Associated with Perceived Fatigue of Local Government Employees Responding to Disasters. J Occup Health 2013. [DOI: 10.1539/joh.12-0095-br] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hideaki Kitamura
- Department of PsychiatryNiigata University Graduate School of Medical and Dental SciencesJapan
- Section of Disaster MedicineNiigata University Research Institute for Natural Hazards and Disaster RecoveryJapan
| | - Masanobu Shindo
- Department of PsychiatryNiigata University Graduate School of Medical and Dental SciencesJapan
| | - Akira Tachibana
- Department of PsychiatryNiigata University Graduate School of Medical and Dental SciencesJapan
| | - Hiroko Honma
- Niigata Institute for Traumatic Stress, Mental Health and Welfare Association in Niigata PrefectureJapan
| | - Toshiyuki Someya
- Department of PsychiatryNiigata University Graduate School of Medical and Dental SciencesJapan
- Section of Disaster MedicineNiigata University Research Institute for Natural Hazards and Disaster RecoveryJapan
- Niigata Institute for Traumatic Stress, Mental Health and Welfare Association in Niigata PrefectureJapan
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Nicdao EG, Noel LT, Ai AL, Plummer C, Groff S. Post disaster resilience: Racially different correlates of depression symptoms among hurricane Katrina-Rita volunteers. DISASTER HEALTH 2013; 1:45-53. [PMID: 28228986 PMCID: PMC5314885 DOI: 10.4161/dish.23077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/30/2012] [Indexed: 11/19/2022]
Abstract
The present analyses examined the differential risks of and protective factors against depressive symptoms of African American and Non-Hispanic White American student volunteers, respectively after Hurricanes Katrina and Rita (H-KR). A total sample of 554 student volunteers were recruited from mental health professional programs at five universities located in the Deep South, namely areas severely impacted by H-KR during fall semester 2005. The response rate was 91% (n = 505). African American respondents (n = 299) and Non-Hispanic White Americans (n = 206) completed the survey questionnaires. Respondents retrospectively provided information on peritraumatic emotional reactions and previous trauma that were recalled by H-KR and H-KR stressors. African American respondents reported higher levels of depressive symptoms (65.2%) than their Non-Hispanic White counterparts (34.8%). Hierarchical regression analyses revealed that disaster related stressors affected African Americans (p < 0.001), but not Non-Hispanic Whites. However, African Americans who experienced peritraumatic positive emotions had lower depression levels. Lower rates of recollection of prior traumas during H-KR were reported by African American respondents, whereas previous trauma recollections predicted symptoms among Non-Hispanic White Americans (p < 0.05). Exhibiting more optimism had lower depression levels among Non-Hispanic White Americans. Peritraumatic negative emotion was the only shared risk for depressive symptoms of both groups. Findings underscore racially different levels of depressive symptoms that may contribute to varying degrees of resilience among student volunteers. Future research and practice may address these racial differences by understanding the risk factors for depressive symptoms to develop appropriate interventions for racial groups, and cultivating the protective factors that contribute to resilience from traumatic experiences.
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Affiliation(s)
- Ethel G Nicdao
- Department of Sociology; University of the Pacific; Stockton, CA USA
| | - La Tonya Noel
- College of Social Work; Florida State University; Tallahassee, FL USA
| | - Amy L Ai
- College of Social Work; Florida State University; Tallahassee, FL USA
| | - Carol Plummer
- School of Social Work; University of Hawaii; Honolulu, HI USA
| | - Sara Groff
- College of Social Work; Florida State University; Tallahassee, FL USA
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Luft BJ, Schechter C, Kotov R, Broihier J, Reissman D, Guerrera K, Udasin I, Moline J, Harrison D, Friedman-Jimenez G, Pietrzak RH, Southwick SM, Bromet EJ. Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers. Psychol Med 2012; 42:1069-1079. [PMID: 22459506 PMCID: PMC3315774 DOI: 10.1017/s003329171100256x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/02/2011] [Accepted: 10/14/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. METHOD Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). RESULTS Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. CONCLUSIONS Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
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Affiliation(s)
- B. J. Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - C. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - R. Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - J. Broihier
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - D. Reissman
- Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA
| | - K. Guerrera
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - I. Udasin
- Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA
| | - J. Moline
- Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA
| | - D. Harrison
- Departments of Medicine and Environmental Medicine, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - G. Friedman-Jimenez
- Departments of Medicine and Environmental Medicine, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA
| | - R. H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - S. M. Southwick
- Department of Psychiatry, Yale University School of Medicine, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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Esposito DH, Han PV, Kozarsky PE, Walker PF, Gkrania-Klotsas E, Barnett ED, Libman M, McCarthy AE, Field V, Connor BA, Schwartz E, MacDonald S, Sotir MJ. Characteristics and spectrum of disease among ill returned travelers from pre- and post-earthquake Haiti: The GeoSentinel experience. Am J Trop Med Hyg 2012; 86:23-8. [PMID: 22232445 DOI: 10.4269/ajtmh.2012.11-0430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To describe patient characteristics and disease spectrum among foreign visitors to Haiti before and after the 2010 earthquake, we used GeoSentinel Global Surveillance Network data and compared 1 year post-earthquake versus 3 years pre-earthquake. Post-earthquake travelers were younger, predominantly from the United States, more frequently international assistance workers, and more often medically counseled before their trip than pre-earthquake travelers. Work-related stress and upper respiratory tract infections were more frequent post-earthquake; acute diarrhea, dengue, and Plasmodium falciparum malaria were important contributors of morbidity both pre- and post-earthquake. These data highlight the importance of providing destination- and disaster-specific pre-travel counseling and post-travel evaluation and medical management to persons traveling to or returning from a disaster location, and evaluations should include attention to the psychological wellbeing of these travelers. For travel to Haiti, focus should be on mosquito-borne illnesses (dengue and P. falciparum malaria) and travelers' diarrhea.
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Affiliation(s)
- Douglas H Esposito
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, Georgia, USA.
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Debchoudhury I, Welch AE, Fairclough MA, Cone JE, Brackbill RM, Stellman SD, Farfel MR. Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry. Prev Med 2011; 53:359-63. [PMID: 21930152 DOI: 10.1016/j.ypmed.2011.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/11/2011] [Accepted: 08/28/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Volunteers (non-professional rescue/recovery workers) are universally present at man-made and natural disasters and share experiences and exposures with victims. Little is known of their disaster-related health outcomes. METHODS We studied 4974 adult volunteers who completed the World Trade Center Health Registry 2006-07 survey to examine associations between volunteer type (affiliated vs. lay) and probable posttraumatic stress disorder (PTSD); new or worsening respiratory symptoms; post-9/11 first diagnosis of anxiety disorder, depression, and/or PTSD; and asthma or reactive airway dysfunction syndrome (RADS). Affiliated volunteers reported membership in a recognized organization. Lay volunteers reported no organizational affiliation and occupations unrelated to rescue/recovery work. Adjusted odds ratios (OR(adj)) were calculated using multinomial regression. RESULTS Lay volunteers were more likely than affiliated volunteers to have been present in lower Manhattan, experience the dust cloud, horrific events and injury on 9/11 and subsequently to report unmet healthcare needs. They had greater odds of early post-9/11 mental health diagnosis (OR(adj) 1.6; 95% CI: 1.4-2.0) and asthma/RADS (1.8; 1.2-2.7), chronic PTSD (2.2; 1.7-2.8), late-onset PTSD (1.9; 1.5-2.5), and new or worsening lower respiratory symptoms (2.0; 1.8-2.4). CONCLUSIONS Lay volunteers' poorer health outcomes reflect earlier, more intense exposure to and lack of protection from physical and psychological hazards. There is a need to limit volunteers' exposures during and after disasters, as well as to provide timely screening and health care post-disaster.
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Affiliation(s)
- Indira Debchoudhury
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 2 Gotham Center, 42-09 28th Street, 7th Floor, Queens, NY 11101, USA.
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Cukor J, Wyka K, Mello B, Olden M, Jayasinghe N, Roberts J, Giosan C, Crane M, Difede J. The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th. J Trauma Stress 2011; 24:506-14. [PMID: 22095774 DOI: 10.1002/jts.20672] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.
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Affiliation(s)
- Judith Cukor
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, USA.
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Abstract
Terrorism has dominated the domestic and international landscape since 9/11. Like other fields, psychiatry was not well prepared. With the 10th anniversary of the 9/11 attack approaching, it is timely to consider what can be done to prepare before the next event. Much has been learned to provide knowledge and resources. The roles of psychiatrists are challenged by what is known of the causes of, consequences of, and responses to terrorism. Reflecting on knowledge from before and since 9/11 introduces concepts, how individuals become terrorists, how to evaluate the psychiatric and behavioral effects of terrorism, and how to expand treatments, behavioral health interventions, public policy initiatives, and other responses for its victims. New research, clinical approaches, and policy perspectives inform strategies to reduce fear and cope with the aftermath. This article identifies the psychiatric training, skills and services, and ethical considerations necessary to prevent or reduce terrorism and its tragic consequences and to enhance resilience.
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Schmidt CW. Study to examine health effects in Deepwater Horizon oil spill cleanup workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:A204. [PMID: 21531657 PMCID: PMC3094437 DOI: 10.1289/ehp.119-a204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Abstract
PURPOSE OF REVIEW This article aims to summarize recent findings relating to the impact of fire disasters on the mental health of victims, responders, families and communities within the context of the existing literature. RECENT FINDINGS Recent studies support previous findings that fire disasters are associated with a negative impact on the mental and physical health of victims, their families and professional and voluntary responders to the disasters. These effects can be delayed in onset and can persist over at least several years, although long-term follow-up studies over 20 years or more indicate that the psychological effects on victims are minimal relative to controls by this stage. SUMMARY Fire disasters, like other natural or man-made disasters, can have significant mental health impact on individuals directly and indirectly affected and on communities caught up in the events.
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Ohlsson A, Shah PS. Effects of the September 11, 2001 disaster on pregnancy outcomes: a systematic review. Acta Obstet Gynecol Scand 2011; 90:6-18. [PMID: 21275910 DOI: 10.1111/j.1600-0412.2010.01020.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The terrorist explosions of the World Trade Center in New York City and the other events on the Pentagon and in Pennsylvania on 11 September 2001 were stressful events that affected people around the world. Pregnant women and their offspring are especially vulnerable during and after such a terrorist attack. The objective was to systematically review the risks of adverse pregnancy outcomes after the terrorist attacks on Sept 11, 2001. METHODS The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used for reporting of this review. Statistical analyses were performed using RevMan 5.0. RESULTS Ten reports of low-to-moderate risk of methodological bias were included. There was increased risks of infants with birthweight of 1,500 g-1,999 g (adjusted odds ratio [AOR] 1.67 [95%CI 1.11-2.52]) and small-for-gestational age births (AOR 1.90; 95%CI 1.05-3.46) in New York. There was increased risks of low birthweight (relative risk 2.25; 95%CI 1.29-3.90) and preterm births (relative risk 1.50; 95%CI 1.06-2.14) among ethnically Arabic women living in California There was a reduction in birthweight by 276 g and in head circumference by 1 cm when DNA adducts, a marker for environmental toxin exposure, were doubled in maternal blood. In Holland, a 48-g reduction in birthweight was reported. CONCLUSIONS The World Trade Center disaster influenced pregnancy outcomes in New York, among ethnically Arab women living in California and among Dutch women. The adverse outcomes are likely due to environmental pollution and stress in New York, ethnic harassment in California and communal bereavement and stress in Holland.
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Affiliation(s)
- Arne Ohlsson
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Canada.
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Biggs QM, Fullerton CS, Reeves JJ, Grieger TA, Reissman D, Ursano RJ. Acute stress disorder, depression, and tobacco use in disaster workers following 9/11. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2010; 80:586-92. [PMID: 20950299 DOI: 10.1111/j.1939-0025.2010.01063.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early posttraumatic psychiatric disorders have not been well studied in disaster workers. This study examined the rates of probable acute stress disorder (ASD), probable depression, increased tobacco use, and their associated risk factors in 9/11 World Trade Center disaster workers. Surveys were obtained from 90 disaster workers (e.g., medical personnel, police, firefighters, search and rescue) 2-3 weeks after 9/11. Nearly 15% of disaster workers had probable ASD and 26% had probable depression. Probable ASD and depression were highly related to functional impairment. The risk for ASD was increased for those with 9/11-specific disaster exposures, more pre-9/11 trauma exposures, and the peritraumatic dissociative symptom of altered sense of time. Disaster workers who were younger, non-White, or who had increasing numbers of peritraumatic dissociative symptoms were more likely to have probable depression. More than half of tobacco users increased their tobacco use after 9/11. Additionally, all tobacco users with probable ASD and almost all tobacco users with probable depression increased tobacco use. Rapid mobilization of resources for early screening and intervention and health promotion campaigns aimed at improving adverse health-related behaviors may be helpful for this high-risk group.
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Affiliation(s)
- Quinn M Biggs
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4712, USA.
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Lynch J, Wathen J, Tham E, Mahar P, Berman S. Disasters and their effects on children. Adv Pediatr 2010; 57:7-31. [PMID: 21056733 DOI: 10.1016/j.yapd.2010.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julia Lynch
- Military Infectious Disease Research Program, US Army, Medical Research and Material Command (US Army, MRMC), 504 Scott Street, Fort Detrick, MA 21702, USA
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